Month: January 2015

What’s Next For Physician Compare?

Jan 23, 2015• 21

By STEVE FINDLAY

Of the many hidden gems in the Affordable Care Act, one of my favorites is Physician Compare. This website could end up being a game changer—holding doctors accountable for their care and giving consumers a new way to compare and choose doctors. Or it could end up a dud.

The outcome depends on how brave and resolute the Centers for Medicare and Medicaid Services (CMS) is over the next few years. That’s because the physician lobby has been less than thrilled with Physician Compare, and, for that matter, with every other effort to publically report measures of physician performance and quality.

I’d give CMS a C+ to date. Not bad considering it’s the tough task. The agency has been cautious and deliberate. But after the many problems with Hospital Compare, Nursing Home Compare, Home Health Compare, and Dialysis Facility Compare—not to mention the shadow of healthcare.gov’s initial rollout—that’s understandable. They want, I hope, to get this one right from the get-go. And competition from the private sector looms.

Dump the Business Model

Jan 22, 2015• 52

By JOE FLOWER

There are no winners in the fee-for-service game.

It’s time to toss the whole business-as-usual model — for your own good and the good of your customers.

The emerging Default Model of health care — the “consumer-directed” insured fee-for-service model in which health plans compete to lower premiums by bargaining providers into narrow networks — not only does not work for health care’s customers, it cannot work. This is not because we are doing it wrong or being sloppy. By its very nature the Default Model must continually fail to bring our customers what they want and desperately need. Ultimately it cannot bring you, the providers, what you want and need.

Take a dive with me into the real-world game-theory mechanics of the health care economy, and you will see why. It’s time to rebuild the fundamental business models of health care.

My World in 2015

Jan 21, 2015• 22

By JACOB REIDER, MD

I started my blog over 15 years ago. Yes – it’s been less active in recent years, and as I reflect on why I’ve been less active – only part of the reason is that I was working for a publicly traded company from 2008-2011 .. and a federal agency from 2011 – 2014. Both of these organizations have reasons to control the messages of their employees. I needed to be cautious about what I blogged. So I didn’t blog publicly very much.

But since November, I’ve had no excuse. And yet nothing much flowed from these fingertips.

It should have. Back in the day – THCB and Docnotes – and a handful of other sites offered bookmarks and observations on health care delivery, the convergence of health care and IT, and random observations. These days – there is a tidal wave of these things on the Internet. I sometimes question whether MY contributions are of any value now that there is so much out there. I remember when Dave Winer toyed with killing his blog. He didn’t. Nor should I. This post celebrates the not-killing of my new blog, and the beginning of the NEXT 15 years of my public observations.

Here goes ..

A Response to Steven Brill

Jan 20, 2015• 51

By ROBERT PEARL, MD

As CEO and Executive Director of The Permanente Medical Group at Kaiser Permanente, I have been following with interest the exchange between Malcolm Gladwell and Steven Brill, prompted by Gladwell’s critique of Brill’s book (America’s Bitter Pill). Gladwell accurately points out that the solution to the problems of the American health care system that Brill puts forth in the book are very close to the structure of Kaiser Permanente. We provide world class hospital and ambulatory care to millions of Americans through our dedicated, physician-led Permanente medical groups, and pay for it through the not-for-profit Kaiser Foundation Health Plan.

Brill dismisses Gladwell’s criticism explaining that “Kaiser Permanente is not the same because it doesn’t have a monopoly, or oligopoly power, in any of its communities. It’s not a teaching hospital. It doesn’t have the network of high-quality doctors, or isn’t perceived to, like New York Presbyterian has in New York or the Cleveland Clinic has in Cleveland.”Continue reading…

My Health Data Is Killing Me

Jan 20, 2015• 9

By TOM GREENE

We are still in the dark ages when it comes to health and fitness data. It reminds me of the early 1990s when I had a paper day planner for a calendar, a business card holder for contacts, and a map.

Then along came the Microsoft Outlook and LotusNotes platform. These two platforms slugged it out like Uber verses Lyft. Then Microsoft integrated MS Office with MS Outlook and it was “game over.” I finally had one place to find everything I needed to do 90% of my job.

I’m waiting for that moment to come to the realm of my fitness data. It’s extremely difficult for me to access my medical and fitness data as it is, and yet the recent CES conference presented hundreds of new ways to collect more of my data. There will be wearables, scales, patches, contact lenses, smartphones, watches, etc. Maybe even a drone to fly overhead and watch what I eat for lunch. It is overwhelming. How overwhelming, you ask?

Let’s start with AppleHealth (HealthKit).

There is a reason Apple gave this app out for free on iOS 8.0. I recall getting the Brickbreaker game for free on my Blackberry in 2004. I played it once on a long flight and never used it again.

HIT Newser: The Flex-IT Bill, Take 2 + Dr. Google In EHR Bid

Jan 20, 2015• 3

By MICHELLE RONAN NOTEBOOM

Flex-IT Bill, Take 2

Lawmakers re-introduce the Flexibility in Health IT Reporting Act of 2015, which would shorten the 2015 MU reporting period from one year to 90 days. The bi-partisan-supported bill earned quick support from HIMSS, CHIME, the AMA, MGMA, and other professional organizations. The bill was originally introduced in September but it failed to pass.

Given the growing disenchantment with the MU program, look for this bill to pass – and hopefully give a boost to attestation numbers.

Dr. Google Joins DoD EHR Bid

Google teams up with PwC, General Dynamics, and Medsphere in their bid for the Department of Defense’s $11 billion EHR bid.

Google brings name recognition and a reputation for innovation and data security. While the Epic/IBM team has been looking like the front-runner, Google puts the PwC/Medsphere/GD team back in the hunt. For those keeping score at home, other vendors in the mix include Cerner/Leidos/Accenture Federal and HP/CSC/Allscripts. A June decision is expected.

The American Healthcare Consumer

Jan 16, 2015• 32

By IAN MORRISON

When you hear the word “empowerment,” it’s code for “You’re on your own, pal.”

Health care leaders are starting to recognize that consumers are becoming a major decision-making force. Let’s be clear at the outset: The rise of the consumer is not the panacea that will solve all our problems. It is a reality that hospitals and health systems must respond to. For the foreseeable future, consumers will pay more for health care and be more involved in picking plans, providers and individual treatment options. This development means significant financial consequences for consumers (unlike almost any other developed country).

Providers need to understand the financial predicament of the typical American health consumer and the responses consumers are making in this changing environment. At the same time, with a new congress and a political season of primaries and posturing just around the corner, pundits, politicians and plutocrats need to recognize where consumers are as voters, plan members, employees, patients and family members.

Will There Be a Sony For Healthcare in 2015?

Jan 16, 2015• 2

By INDUSTRY SKEPTIC

In 2015 I think there is a good chance we’ll see a major security incident along the lines of this month’s Sony hack. This event will be like 9/11, in the sense that there will be a before and an after, and life as we know it will change forever. This has been coming for a long time. We’ll finally see how vulnerable we are and there will be a public outcry, most likely leading to some kind of government action. Up until now, most incidents have been security breaches of the disgruntled employee and clueless user variety, which are a huge big deal as far as HIPAA lawyers and privacy advocates are concerned, but not a very real threat to anybody.

This will be the real thing, with potentially disastrous results. I don’t know if this will be an attack on Healthcare.gov by a politically-motivated hacker group. (I’m surprised it hasn’t happened already. ) Or an attack on a academic hospital system designed to acquire potentially valuable patient and research data. Or a hack of a health insurance company, intended to Wikileak financial and (possibly damaging) patient claims data. For an insurer with a poor track record, this could cause serious problems.

2015: The Year We Finally Meet The Triple A

Jan 15, 2015• 2

By CYNDY NAYER

Since 2002, and possibly before, there have been moments of clarity and innovation in the health care sphere, from patient-centered to consumer-driven to value-based to outcomes design, from iPhone texts to wellness to electronic medical records to blue buttons and transparency. Yet the year 2015 will certainly be the standout year of transformation, most noted for the interstellar collision of all of these siloed ideas into the supernova Triple-A.

This is the year that the person reclaims his or her health.

The Triple A is not exactly the Triple AIM of Dr. Don Berwick (his is patient-centeredness, cost effectiveness and positive patient experience). Instead, this Triple A happens within and is directed by the person, whom we will identify as over age 18 and able to make decisions for him/her self.

The Triple A is marked by the following dimensions: Awareness, Activation and Accountability.

Invaders from Mars with Commentary from Robert Burns

Jan 15, 2015• 2

BY MARTY SAMUELS, MD

Just over a half-century ago, in the mid-50s, at the height of our paranoia about communists and the Soviet Union, a boy sees a flying saucer land in the distance. No one else sees the event. The occupants of the mysterious spacecraft prove to be invaders from Mars. Their strategy is to capture people, one-by-one, and to perform brain surgery on them whereby an electrode controlling device is placed in the victims’ brains rendering them pawn
s of the invaders, though they retain the superficial appearance of human beings. The only clue to recognizing one of these unfortunate robots is to look for the telltale antenna at the base of the hairline in the back of the neck.

In order to understand the profound meaning of the Invaders from Mars, you have to know a little neurology.

There are really two people within each of us, a fact that reflects the two almost mirror image cerebral hemispheres, each responsible for the opposite side of the body and extra-personal space. Put simply, damage to the left hemisphere will cause paralysis and loss of sensation on the right side of the body, including loss of perception from the right side of the world.

This loss of perception is more profound than simple blindness. If reflects the fact that anything that the brain does not record is actually not there. We live, after all, in virtual reality. What our brains do not sense is, for us, not there. Do the following experiment. What is behind your head? Not what you imagine might be there or what you think you remember is there. What is actually there? Is it black, white, striped? Try to describe it. You don’t have the words, because what is there is nothing, and nothing has no color, texture or shape. Is there an antenna at the base of your hairline? You couldn’t possible know, could you?